Strongyloides

Previously mentioned 'strongy' here. CMAJ reviews here, and here.

There was an extensive discussion at case-rounds yesterday afternoon about prophylaxis for strongyloidiasis in patients at risk who will be immunosuppressed.

Here is a review of strongyloidiasis in the immunocomprimised patient.

This article discusses prevention in patients with connective tissue diseases.

In patients with bone marrow transplantation or solid organ transplantation recent guidelines suggest that patients with unexplained eosinophilia or who have lived/travelled in areas endemic for strongyloidiasis, even if remotely, should be screened prior to transplant with stool O&P time three and serology. Positive screening or eosinophilia should prompt pre-emptive treatment prior to transplant with ivermectin. Mind you, some experts would suggest, given the few side effects, that people who have lived in endemic areas should just be treated...

Recent case report of death due to strongyloides in patient with HSCT...

Strongyloides - The saga continues

We discussed strongyloidiasis at length again today.

See previous blogs on 'strongy' here and a previous blog on eosinophilia here.

Day #314 - Pulmonary Eosinophilia

Very complex case facilitated by an expert discussant. The key focus, other than on the case at hand was a demonstration of clinical reasoning and Bayes theorem.

We highlighted the importance of Occam's Razor -- but stressed the importance of recognizing Hickam's dictum.

I have previously blogged about pulmonary eosinophilia here (with references). In my mind, an important consideration in this patient (given travel to China) is to exclude disseminated strongyloidiasis because like infliximab related interstitial lung disease (NEJM article here) 'strongy' can appear to improve on steroids.

This is a recent review from the Lancet on TNF-alpha blockade and the interaction with tuberculosis.

NB: Review of radiographic manifestations of pulmonary TB.